Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2013
Comparative StudyA comparison of VerifyNowR with PlateletMappingR--detected aspirin resistance and correlation with urinary thromboxane.
Aspirin-resistant platelet activation in whole blood is attributable to a transcellular pathway not detected by isolated platelet aggregometry. Aspirin resistance as defined by urinary thromboxane levels is associated with increased risk for myocardial infarction or cardiac death. Whole blood point-of-care assays may also detect aspirin resistance. ⋯ These results indicate that PlateletMapping could be a useful point-of-care assay to identify aspirin-resistant patients for better perioperative risk stratification and management.
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Anesthesia and analgesia · Feb 2013
Incidence, predictors, and outcomes of perioperative stroke in noncarotid major vascular surgery.
Perioperative stroke is a potentially catastrophic complication of surgery. Patients undergoing vascular surgery suffer from systemic atherosclerosis and are expected to be at increased risk for this complication. We studied the incidence, predictors, and outcomes of perioperative stroke after noncarotid major vascular surgery using the American College of Surgeons National Quality Improvement Program database. ⋯ Perioperative stroke is an important source of morbidity and mortality, as reflected by significant increases in median surgical length of stay and all-cause 30-day mortality. The independent predictors of stroke that we have identified in this population are not readily modifiable and the majority of strokes occurred after postoperative day 1. Additional studies are required to identify potentially modifiable intraoperative or postoperative risk factors of perioperative stroke.
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Anesthesia and analgesia · Feb 2013
Technical communication: First robotic ultrasound-guided nerve blocks in humans using the Magellan system.
Ultrasound-guided nerve blocks are becoming a standard of modern anesthesia. We developed a robotic system, Magellan, to perform nerve blocks using a remote control center. ⋯ We present the first human testing of a robotic ultrasound-guided nerve block system. The success rate was 100%. The total performance time was approximately 3 minutes to 4 minutes.
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Anesthesia and analgesia · Feb 2013
Case ReportsCase report: Perioperative pacemaker-mediated tachycardia in the patient with a dual chamber implantable cardioverter-defibrillator.
Patients with cardiac implantable electronic devices are at additional risk for arrhythmias while undergoing surgical procedures. In this case report, we present a patient with a dual chamber implantable cardioverter-defibrillator who developed intraoperative pacemaker-mediated tachycardia causing significant hemodynamic instability. Management of this arrhythmia can be particularly challenging, because standard application of a magnet does not affect the pacing functions of an implantable cardioverter-defibrillator. Awareness by the anesthesiologist and timely coordination with the cardiac electrophysiology team helped to optimize care for this patient.
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Anesthesia and analgesia · Feb 2013
Determinants of a subject's decision to participate in clinical anesthesia research.
A top priority for research studies is to ensure that potential participants receive adequate information to make a truly informed decision. Understanding patient experiences with the recruitment process may identify areas for improvement in the consent process. We examined which factors were associated with the decision to consent in a clinical research study. ⋯ The 2 strongest predictors of consent were male gender and comfort; predictors of refusal were protocol type that requires additional testing, greater concern about blood sampling and study risks, and lower overall patient comfort with the study. These patient and study characteristics may inform modification of the consent process for clinical research studies and facilitate the development of more accurate enrollment projections and strategies.